| NPI | 1942201348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KS 0423283) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO MD114207) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2014-09-25 |